Shingles (Herpes Zoster) (cont.)

Steven Doerr, MD

Steven Doerr, MD, is a U.S. board-certified Emergency Medicine Physician. Dr. Doerr received his undergraduate degree in Spanish from the University of Colorado at Boulder. He graduated with his Medical Degree from the University Of Colorado Health Sciences Center in Denver, Colorado in 1998 and completed his residency training in Emergency Medicine from Denver Health Medical Center in Denver, Colorado in 2002, where he also served as Chief Resident.

John P. Cunha, DO, FACOEP

John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

What causes shingles?

Shingles is caused by reactivation of the varicella zoster virus, the same virus that causes chickenpox. Only those who have previously had chickenpox and those who have received the varicella vaccine can develop shingles later in life. Initial exposure to the varicella zoster virus, which typically occurs in children or adolescents, leads to the development of chickenpox. After the episode of chickenpox has resolved, the virus remains in a dormant state in certain nerve cells of the body. While in this inactive state, you will not experience any symptoms from the varicella zoster virus. However, in certain individuals and for reasons that are not completely clear, the varicella zoster virus may reactivate years later and travel along nerve paths to cause shingles. The location and pattern of the ensuing rash reflects the region of the affected nerves.

Though similar in name, herpes zoster is not the same disease as herpes simplex (which is caused by the herpes simplex virus causing cold sores, fever blisters, or genital herpes).

What are risk factors for shingles?

Shingles can only occur in individuals who have previously been exposed to the varicella zoster virus. Risk factors for the development of shingles include the following:

Increasing age: Though shingles can rarely occur in children, it is much more common in older adults, increasing with age. This is thought to be in large part due to waning immunity as people age. Approximately 50% of all cases of shingles occur in adults 60 years of age or older.

Weakened immune system: Individuals with impaired immune systems have a higher probability of developing shingles. This can be seen in diseases such as cancer and HIV/AIDS, or in individuals taking certain medications. Patients taking steroids or other immunosuppressive medications, such as people who have undergone organ transplantation, and individuals with certain autoimmune diseases (such as rheumatoid arthritis, systemic lupus erythematosus, Crohn's disease, and ulcerative colitis) are at increased risk for developing shingles. Psychological and emotional stressors are also thought to possibly contribute to the development of shingles, perhaps from the detrimental effects of stress on the immune system.